Provider Demographics
NPI:1194743005
Name:INTERNAL MEDICINE OF FREDERICKSBURG
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF FREDERICKSBURG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BOZENA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLANSKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-899-3410
Mailing Address - Street 1:2216 PRINCESS ANNE ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-3300
Mailing Address - Country:US
Mailing Address - Phone:540-899-3410
Mailing Address - Fax:540-899-3413
Practice Address - Street 1:2216 PRINCESS ANNE ST
Practice Address - Street 2:SUITE 107
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-3300
Practice Address - Country:US
Practice Address - Phone:540-899-3410
Practice Address - Fax:540-899-3413
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2014-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233578207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08658Medicare PIN